Patient-reported outcomes and quality of life in carotid revascularization: A narrative review

Traditional carotid revascularization outcome measures often overlook meaningful changes in outcomes important to patients. Patient-reported outcomes are being used more often to assess how diseases and treatments affect these outcomes, with these insights gathered through patient-reported outcome measures (PROMs). This narrative review summarizes the PROM instruments applied in carotid revascularization studies, highlights key findings regarding quality of life (QoL) before and after intervention, and examines methodological challenges inherent to PROM implementation. Generic PROMs are most often used in carotid revascularization research, with most studies describing QoL changes after carotid endarterectomy in symptomatic patients using the generic 36-Item Short Form Survey PROM. Symptomatic patients can expect a return to baseline QoL by 1 year after intervention. Trial data suggest carotid artery stenting confers a short-term QoL benefit with equivalency to carotid endarterectomy by 1 year. There is insufficient high-quality data to evaluate QoL and revascularization for asymptomatic patients, compare best medical therapy with intervention, or compare the effect of surgical technique on QoL. Interpretation of PROM and QoL data in carotid revascularization research to date is limited by heterogeneity in study methodology and PROM choice and validation. Most PROMs used in carotid revascularization are not validated and lack consensus for testing intervals, patient stratification, and the type of PROM that best reflects patient perceptions. Future work should emphasize the development of carotid disease-specific PROMs to best capture patient-reported outcomes and guide clinical decision making.